ppi reduces exacerbations of copd

Embargoed For Release Dr. Anka Stegmeier-Petroianu 10:00 CETSeptember 14thChronic obstructive pulmonary disease Proton pump inhibitor reduces risk of exacerbations VIENNA – Proton pump inhibitors (PPIs), a class of drugs used in the treatment of gastroduodenal ulcers and gastroesophageal reflux disease, may also be of benefit to patients suffering from chronic obstructive pulmonary disease (COPD), suggests a Japanese study presented at the 19th Annual Congress of the European Respiratory Society. Patients affected by COPD not only suffer from shortness of breath due to an irreversible limitation of airflow; they are predisposed to recurring respiratory infections, which in turn aggravate their condition—so-called exacerbations—with the risk of lung function deteriorating below the individual patient’s baseline prior to the exacerbation. Previous experimental studies on tracheal epithelial cells had shown that the proton pump inhibitor lansoprazole inhibits production of proinflammatory cytokines also believed to be implicated in the pathogenetic mechansim of rhinovirus infection. In this new study, Japanese researchers enrolled 103 patients with confirmed chronic obstructive pulmonary disease. All patients continued their usual medications with bronchodilators such as theophylline, beta-agonists and inhaled anticholinergic agents throughout the observation period, and some of the patients were also on inhaled corticosteroids. Patients who had symptoms suggestive of gastroesophageal reflux disease were excluded from the study; in fact, all patients had also undergone endoscopy to exclude any gastroduodenal disease.
In the prospective study with 100 analyzable results, 50 patients were in the active group receiving a PPI(lansoprazole 15 mg /d) and 50 patients were in the control group over a period of 12 months. During this period any symptoms suggestive of a common cold, such as sneezing, runny nose, headache, sore throat, or cough, were recorded and rated with a symptom score from 0 to 30. The diagnosis of ―common cold‖ was established if a symptom score higher than five was recorded. The criterion of acute exacerbation was met if patients experienced an acute worsening of COPD symptoms necessitating a change in regular medication, such as the addition of an antibiotic or a course of systemic corticosteroids. In the PPI group, the absolute number of common colds was lower than in the control group, but the difference (1.22 vs 2.04) was not statistically significant. However, the total number of exacerbations over the one-year study period was significantly lower in the PPI group than in the control group (0.34 vs 1.18, p < 0.001). After adjustment for confounding factors such as age, previous influenza vaccination, and COPD stage, use of a PPI was independently and significantly associated with a lower risk of having frequent common colds (> 3 per year) and with a lower risk of COPD exacerbations.
―In as many as half the infections of COPD-patients, common colds
caused by rhinoviruses seem to be the trigger to exacerbations,‖ explains Takahiko Sasaki, MD, PhD, from Tohoku University Graduate School of Medicine, Sendai, Japan. Lansoprazole was found to modulate inflammatory responses after rhinovirus infection. ICAM-1 is the main infection receptor used by rhinoviruses. Lansoprazole not only in-vitro suppresses ICAM-1 but also decreases production of proinflammatory cytokines, thereby preventing rhinovirus infection. The risk of catching common colds frequently (more than three times per year) was reduced by 72% in the group receiving a proton pump inhibitor, as compared to controls. In fact, the risk of COPD exacerbations was significantly reduced, by 77%. ―These findings led us to believe that, when added to conventional therapy, low-dose proton pump inhibition could prevent exacerbations in COPD-patients‖ says Dr. Sasaki. The ERS is an organization of and for physicians, health professionals, and scientists that advances lung health through of education, research, advocacy and practice support that foster excellence in the field of respiratory medicine. For more information, see
Abstract No: 603 Title: The proton pump inhibitor reduces the frequency of exacerbations in patients with chronic obstructive pulmonary disease (COPD) Author contact